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Monitoring responseThis involves elements of art as well as science. The aim is to taper theprednisolone to find the minimum dose required to hold the disease in remission, whichin some patients on an additioni:ll immunosuppressant drug may be zero. Although it isoften emphasised that one should treat the patient, not the blood test, a rising SCK is acause for concern and may herald recurrence. On the other hand, recurrence, withincreasing weakness, can occur with no increase in SCK. Steroid induced myopathy is atheoretical concern, but appears to be rare on an alternate day dosage regime. As withmany other autoimmune diseases, the disease may be held in pharmacological remission,but "cure" is more elusive. In our experience, long term drug-free remission is morecommon in DM than PM.Inclusion body myositisMost patients with typical IBM do not have a useful response to steroids,immunosuppressant drugs, or intravenous immunoglobulin. If after informed discussionthey are keen to attempt drug treatment, then I would use an 18-24 month trial ofprednisolone and azathioprine (or methotrexate) as outlined above. The prednisolonewould be tapered until the SCK started to rise. Treatment would only continue if therewas unequivocal benefit. The potential side. effects should not be underestimated and inthe ·last year we have seen death from cytomegalovirus pneumonia, and salmonellainfection in an artificial hip.Atypical cases make me more inclined to propose a trial of treatment, but as yetthe evidence base for doing 'this is lacking. Features might include onset in early adultlife, pronounced inflammatory infiltrates on biopsy, exceptionally high SCK, andassociated immune disorders18
AGE DISTRIBUTION• < 18yrs|»18-50Yre•>50yrsFig 1: Pie chart showing age distribution: total 84 casesSEX DISTRIBUTIONI MaleI FemaleFig 2: Pie chart showing sex distribution: total 84 casesNumber50403020100With painwithout painFig 3: Picture showing the comparison of number of cases withpain /tenderness Vs without pain: total 84 cases
Page 1 and 2: Sree Chitra Tirunal Institute forMe
Page 3 and 4: PROJECT REPORTCLINICAL, ELECTOPHYSI
Page 5 and 6: CONTENTS1. INTRODUCTION2. REVIEW OF
Page 7 and 8: • IdiopathicClassification of the
Page 9 and 10: CLINICAL FEATURESMany inherited myo
Page 11 and 12: PolymyositisEvolution of weakness i
Page 13 and 14: The rate of progression is typicall
Page 15 and 16: Muscle biopsyPathological feature D
Page 17: controlled trial. These have includ
Page 21 and 22: Deep tendon reflexes2 40S 30° 201
Page 23 and 24: EMG• Myopathic• Neurogenic• N
Page 25 and 26: Picturel9: Light microscopy: Histop
Page 27 and 28: AIMS AND OBJECTIVES OF THE STUDY1.
Page 29 and 30: Diagnostic Criteria for Inclusion B
Page 31 and 32: L ower r 1m b prox1m . al we akn es
Page 33 and 34: Final diagnosis:DiagnosisFrequencie
Page 35 and 36: Prognostic factors: There was no st
Page 37 and 38: cases. Other common symptoms includ
Page 39 and 40: 5 (17%) liM with neoplasia (lymphom
Page 41 and 42: Follow up:Mean follow up period was
Page 43 and 44: REFERENCESl.Amato AA et al. Inclusi
Page 45 and 46: Clinical, electrophysiological and
Page 47 and 48: 5.4 Not treated6.0Follow-up: 3 mont
Page 49 and 50: 1 0.6 ESR.1. Improved 2 .stationary

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